Provider Demographics
NPI:1891794038
Name:KOMADINA, STEVEN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:KOMADINA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4801 MCMAHON BLVD NW
Mailing Address - Street 2:#101
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5090
Mailing Address - Country:US
Mailing Address - Phone:505-893-2840
Mailing Address - Fax:505-893-2844
Practice Address - Street 1:4801 MCMAHON BLVD NW
Practice Address - Street 2:#101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5090
Practice Address - Country:US
Practice Address - Phone:505-893-2840
Practice Address - Fax:505-893-2844
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-12-15
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Provider Licenses
StateLicense IDTaxonomies
NM71-165207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03244Medicaid
NM03244Medicaid
NMC97898Medicare UPIN